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General NPI Number Information
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NPI Number | 1073046587
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Entity Type | Organization
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Legal Business Name | WELLCARE FAMILY MEDICINE PLLC
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Dates
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Enumeration Date | 04/11/2017
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Last Update Date | 04/11/2017
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Provider Practice Location Address
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Address Line | 517 RUSSELL ST SUITE C
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City | DUNLAP
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State | TN
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Zip | 37327-3648
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Country | US
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Telephone | 423-949-9355
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Fax | 423-949-9358
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Provider Business Mailing Address
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Address Line | 517 RUSSELL ST SUITE C
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City | DUNLAP
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State | TN
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Zip | 37327-3648
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Country | US
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Telephone | 423-949-9355
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Fax | 423-949-9358
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | ANGELA LOUISE BUCKNER
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Credential | APN
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Telephone | 423-949-9355
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APN16901
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License Number State | TN
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